Provider Demographics
NPI:1609338052
Name:WIEST, MAYA CS
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:CS
Last Name:WIEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VALLEY MALL PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5348
Mailing Address - Country:US
Mailing Address - Phone:509-888-6977
Mailing Address - Fax:
Practice Address - Street 1:100 VALLEY MALL PKWY STE 5
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5348
Practice Address - Country:US
Practice Address - Phone:509-888-6977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60924280225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist